Thursday, May 14, 2020

Thoughts

"Insomnia is a glamorous term for thoughts you forgot to have in the day." (Alain de Botton)

Insomnia is difficulty falling asleep or staying asleep even when a person has the chance to do so. People with insomnia can feel dissatisfied with their sleep and usually experience one or more of the following symptoms: fatigue, low energy, difficulty concentrating, mood disturbances, and decreased performance in work or at school. Insomnia may be characterized based on its duration.

Short-term (acute) insomnia is brief and often happens because of life circumstances (for example, when you can't fall asleep the night after receiving bad news). Many people may have experienced Short-term (acute) insomnia. It tends to resolve without any treatment. It can last one night to a few weeks. Long term (chronic) insomnia is disrupted sleep that occurs at least three nights per week and lasts at least three months or more.

There are two types of insomnia. Primary insomnia sleep problems aren’t linked to any other health condition. Secondary insomnia  means you have trouble sleeping because of a health condition (like asthma, depression, arthritis, cancer, or heartburn); pain; medication; or substance use (like alcohol). Insomnia affects women more than men and older people more than younger ones.

Young and middle-age African Americans also have a higher risk. People with insomnia tend to have difficulty falling asleep (onset), staying asleep (maintenance), and/or they wake up too early in the morning. Treatment for insomnia can include behavioral, psychological, medical components or some combination of any of these.

Falling asleep and staying asleep are natural activities. Symptoms of insomnia include sleepiness during the day, fatigue, grumpiness, and problems with concentration or memory. Good sleep hygiene is important for quality sleep. Before seeing a sleep doctor (somnologist), here are a few hints you can try to improve your sleep from OhioHealth Pulmonologist and Certified Nurse Practitioner (CNP), Cathy Gail Benninger:

 Alcohol-Alcohol slows brain activity which can help you fall asleep but it can cause awakenings during the night, nightmares, and early morning headaches. Alcohol can make sleep apnea or restless legs worse. Avoid alcohol within 4-6 hours before bedtime.

Exercise-Exercise is important to stay healthy. Low amounts or no exercise during the day can affect sleep because you don't feel tired. Heavy exercise close to bedtime can make it hard to fall asleep. Avoid heavy exercise within 4-5 hours before bedtime.

Apps to consider- CBT i coach, sleep cycle alarm clock (free), yoga for insomnia ($2.99), sleep genius ($4.99), sleep pillow sounds ($2.99), and white noise lite (free).

Bed partner-Bed partners may have sleep problems such as snoring or restless sleep that can affect your sleep. If your bed partner has sleep problems talk to them about a sleep study (polysomnography).

Caffeine- Caffeine is a stimulant that can stay in your body for 10-12 hours. A small amount of caffeine in the morning usually does not affect sleep. High amounts of caffeine during the day or caffeine late in the day can make it hard to fall asleep (or stay asleep). Coffee, tea, carbonated sugary drinks, cocoa, chocolate, and some medicine with caffeine should not be taken within 4-5 hours of bedtime. If you are still having problems, avoid caffeine for 10-12 hours before bedtime, or cut it out altogether.


Decrease awake time in bed-People who have trouble sleeping sometimes start to hate bedtime. This can lead to behaviors like sleeping in a chair; staying up late; sleeping in; or using caffeine, alcohol or medicines to "wake up" or "fall asleep". Get back on schedule with good sleep hygiene and stimulus control.

Stimulus control- Try to sleep only when you are drowsy. If you are unable to fall asleep or stay asleep within 20 minutes, leave your bedroom and engage in a quiet activity elsewhere such as reading. Do not let yourself fall asleep outside the bedroom. Return to bed when and only when you are sleepy. Repeat as often as necessary throughout the night. Maintain a regular schedule for going to bed and getting up even on days off work and on weekends. Use your bedroom only for sleep and sex. Hide your alarm clock so you cannot see the time.

Diet-A light snack of milk or cheese before bedtime can help with sleep. A large or full meal can cause indigestion or acid reflux and affect your sleep. Avoid eating a meal within 3 hours of bedtime.

Environment-A comfortable bed in a dark, quiet room is best for a good night's sleep. Blackout curtains or blinds can be helpful. Cut out noise with "white noise" (fan or white noise machines) or earplugs. The room should be cooler at night than during the day. Avoid falling asleep with the television on and do not use your computer or other back-lit electronic device within 1-2 hours of bedtime. Avoid night lights in the bedroom.

Nicotine-Nicotine is a stimulant that can affect sleep. Cigarettes and some drugs have high levels of nicotine. In heavy smokers, nicotine withdrawal can cause awakenings during the night. Ex-smokers tend to fall asleep faster and wake up less during the night. Until you are able to quit, avoid smoking or chewing tobacco close to bedtime.

Sleep- Avoid daytime naps if possible. If you need to take one in the afternoon, sleep before 3pm so it won’t interfere with that evening’s sleep.
The afternoon nap should be no more than one hour in length. You may find you need to go to bed earlier since you are not sleeping as long during the day. You may want to plan your nap between your usual nap times. For example if you nap at 8 am and 2 pm plan your nap for 11 am. Give yourself at least seven hours of sleep during the night. Try to get more activity during the day.

Stress-Stress can cause sleep problems. Activity such as relaxation exercises, meditation, biofeedback, calming music, massage, journaling or coloring before bedtime can help relieve tension.

Worry- Schedule "Worry Time". Talk with a friend, family member or counselor about problems or set aside 30 minutes in the evening to sit alone and write down your worries. Write 1 worry per 3x5 index card. When all worries have been written down, put the cards in order with the item you are most worried about on top. Look at each card and write down what you can do about it. Go to bed without worry knowing you have a plan. Each day look at the worry cards, and work on your plan.

"Insomnia is an increasing problem. I've become convinced that sleep disorders are perhaps the most overlooked, ignored, underrated cause of health and performance problems in the workplace." (Sean Sullivan)[i]



[i] Sources used:

·        “What is Insomnia?” by the National Sleep Foundation

·        “Insomnia” Reviewed by Melinda Ratini

·        “Sleep Doctor: Sleep Disorder Specialist” by American Sleep Association

·        “Polysomnography (sleep study)” by Mayo Clinic
 

 

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